J7294 Medicaid reimbursement rates by state
Segesterone acetate and ethinyl estradiol 0.15mg. 20 state Medicaid programs publish a fee-for-service rate for J7294 at the physician psychologist level. Rates run from $339.96 in Kentucky to $2,585.14 in Nebraska, with a median of $2,315.28.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 20
- Median rate
- $2,315.28units vary by state
- Highest
- $2,585.14Nebraska
- Medicare (non-facility)
- —not on the physician fee schedule
J7294 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $2,585.14since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $2,565.77since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Title X Family Planning Clinic, Ja |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $2,541.57since 2024-10-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $2,468.96since 2026-04-01 | — | — | Plans must pay at least this | — | TMHP Texas Medicaid Fee Schedule - Famil |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $2,420.54since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Family planning fee schedule (family |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $2,420.54since 2024-10-01 | — | — | Not classified | — | Q1/Q2/Q3/Q4 2024 PAD Fee Schedule |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $2,420.54since 2025-01-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Office of Public Heal |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $2,381.82since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | SCDHHS Nurse Midwives Fee Schedule (sche |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $2,334.79since 2024-03-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $2,316.51since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Physician-Administered Drug Rat |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $2,314.04since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $2,305.28since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule (Wayback capture 20250 |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $2,236.30since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $2,233.82since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $2,090.00since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $2,090.00since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $2,069.10since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $2,000.00since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $1,248.90since 2026-07-04 | — | — | Not classified | — | CMAP fee schedule: Clinic - Family Plann |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $339.96since 2022-07-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Preventive fee schedule (202 |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for J7294?
It depends on the state. Of the 20 states with a published fee-for-service rate, the median is $2,315.28. Nebraska pays the most ($2,585.14) and Kentucky the least ($339.96).
Which state pays the highest Medicaid rate for J7294?
Nebraska, at $2,585.14, effective 2026-07-01.
Do managed-care plans pay the same rate for J7294?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.
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